2. Mission Not Impossible Reducing UTIs in the ICU Jeanine Baskin RN BSN CCRN

3. Novant Health at a Glance Novant Health is a not-for-profit integrated healthcare system in Western North Carolina that serves more than 3.4 million people in 34 counties reaching from southern Virginia to northern South Carolina. Novant Health is a not-for-profit integrated healthcare system in Western North Carolina that serves more than 3.4 million people in 34 counties reaching from southern Virginia to northern South Carolina. Mission Statement: Novant health exists to improve the health of the communities one person at a time. Mission Statement: Novant health exists to improve the health of the communities one person at a time.

4. Novant Health summary statistics Over 1,900 active medical staff Over 1,900 active medical staff 670 employed physicians 670 employed physicians 17,705 employees 17,705 employees 2382 licensed beds 2382 licensed beds $200 Million+ in Annual Cash Flow $200 Million+ in Annual Cash Flow Population of 3 million in three markets Population of 3 million in three markets 96,000 inpatient discharges 96,000 inpatient discharges

5. The Healthcare system of Novant summary statistics 7 Inpatient hospitals 7 Inpatient hospitals 28 Outpatient facilities 28 Outpatient facilities 2 Long-term care facilities 2 Long-term care facilities 102 clinic locations 102 clinic locations

6. Forsyth Medical Center Winston-Salem, NC An 847 bed not for profit, tertiary care hospital offering a full continuum of emergency, medical, surgical, rehabilitative and behavioral health services. ~ SMOKE FREE campus as of April 2 nd ~

7. Our Critical Care Services 30 Medical /Surgical beds (TICU participant) 30 Medical /Surgical beds (TICU participant) 10 Neuro / Neurosurgical beds 10 Neuro / Neurosurgical beds 8 Cardiovascular Surgical beds 8 Cardiovascular Surgical beds 20 Coronary Care beds 20 Coronary Care beds

8. ICU Process Improvement Team Summary of projects Multidisciplinary PI/TICU Team 1) VHA TICU wave 6 participants (OCT 2005) VAP, BSI reduction, Sepsis work 2) IHI 100K and 5 Million Lives campaigners (since June of 2005) VAP, BSI initiatives, reducing med errors

9. Houston – We have a Problem!!! Jan-06 to May- 06

10. Jan-06 to May- 06

11. Where do we start???

12. Attention secret agents (AKA ICU Staff) The National Nosocomial Infections Surveillance (NNIS) System Report has surveyed selective hospitals in the US since 1970. Their surveillance data is aggregated into a national database. According to their surveillance, the UTI rate in the ICU at Forsyth Medical Center is considerably higher than the national average... The national average is 3.1% for other ICUs compared to FMC. In the first quarter of 2006, the average was 8.4% This is a serious and potentially deadly situation.

13. Mission Not Impossible At the end of this briefing you should know how to reduce high UTI rates at FMC. Always check allergies before using betadine on all patients. Reducing UTIs in the ICU

14. The Impossible Team in 1966

15. The Impossible Team in 1996

16. The Plan: Mission Not Impossible! The Team The Team Staff NursesStaff Nurses ManagementManagement Infection ControlInfection Control

17. The Not Impossible Team in 2006

18. Mission Not Impossible Reducing UTIs in the ICU is in your hands!

19. The most effective way to do it, is to do it! The most effective way to do it, is to do it! Amelia Earhart 1897-1937 Amelia Earhart 1897-1937

20. What we Did! PDSA Plan Plan Do Do Study Study Act Act

21. The DO Recruited staff nurse Recruited staff nurse Career Ladder /Sabbatical incentiveCareer Ladder /Sabbatical incentive 1) Increase awareness of the problem 1) Increase awareness of the problem Boards with data posted Boards with data posted Flyers place in all bedside notebooks. Flyers place in all bedside notebooks. Posters in break-rooms Posters in break-rooms 2) Education, education, education!!! Power point for staff Power point for staff

22. Placed emphasis on: Handwashing Handwashing DC all FCs when patients are extubated unless medically necessary. DC all FCs when patients are extubated unless medically necessary. Pericare twice daily Pericare twice daily Marking cath bags with insertion of FC dates Marking cath bags with insertion of FC dates Cath secure devices Cath secure devices Sterile technique Sterile technique Dependent Placement of bags Dependent Placement of bags Catheter size selection Catheter size selection Emptying the bag and clamping the foley prior to patients transfer Emptying the bag and clamping the foley prior to patients transfer

23. Barriers Educating of all nursing staff- Low attendance of nurses due to time constraints. Educating of all nursing staff- Low attendance of nurses due to time constraints. Took DVDs to individual podsTook DVDs to individual pods Changing actual practice

24. The Study

25. The Act: So what do we do now??? Continued awareness via posting, sharing information, UCIC Continued awareness via posting, sharing information, UCIC Continue Education, education, education!!! Continue Education, education, education!!!

26. New suggested UTI bundle Plan – Begin a new study, different staff nurse Plan – Begin a new study, different staff nurse Do - Collecting new bundle Do - Collecting new bundle Study - Analyze the information we collect. Study - Analyze the information we collect. Act - Where do we need to go from here? Act - Where do we need to go from here?

27. Success is never ending, failure is never final. Robert Schuler